E-Cigarettes May Serve as Gateway to Smoking for Teens, Study Suggests

At the Henley Vaporium in SoHo, guests puff on or “vape” e-cigarettes.Credit Katie Orlinsky for The New York Times

When I was in middle school, I asked my mom if she would be mad if I tried smoking. I’ve never forgotten her answer: “Go ahead and try it,” she said. “You’ll hate it, and you’ll never want to do it again.” So about a year later, when the opportunity presented itself, I took a puff off an older kid’s cigarette in a public bathroom. I could barely inhale, and I’ve never had the desire to try one since.

My mom’s antismoking strategy made such an impression that I’ve always thought I would take the same tack with my daughters, who are now 6 and 3. Unfortunately, thanks to the advent of the e-cigarette — with its smooth delivery system and sweet flavorings — this approach may blow up in my face.

E-cigarettes, which are battery-charged devices that vaporize liquid nicotine, are changing how kids experience cigarettes today and winning over teens at an alarming rate. From 2011 to 2013, the number of middle and high school students who had used e-cigarettes (and never used regular cigarettes) tripled, going from about 79,000 to more than a quarter of a million. Of those, “43.9 percent said they have intentions to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e-cigarettes,” according to a study from the Centers for Disease Control and Prevention and published in Nicotine and Tobacco Research.

Though some public health experts have argued that e-cigarettes are a valuable smoking-cessation tool for current smokers, others have concluded that e-cigarettes do not discourage, and may encourage, a new generation of smokers of conventional cigarettes. The hot debate, then — which The New York Times has been covering in a series of articles — is whether e-cigarettes are serving as a gateway away from nicotine use or toward it.

A study published online Monday in the journal Pediatrics seems to add to the evidence suggesting that e-cigarettes are doing more to promote nicotine use, and possibly eventual smoking of conventional cigarettes, than to help people quit. The study, which surveyed ninth and 10th graders in Hawaii in 2013, found that 29 percent of students used e-cigarettes, a number much higher than previous estimates. The researchers also compared e-cigarette users to regular cigarette users and found that 17 percent of the students used e-cigarettes only, 12 percent used both e-cigarettes and cigarettes (called “dual use” in the study) and 3 percent used only cigarettes. Rates of conventional cigarette smoking in Hawaii are lower than the rest of the United States because of Hawaii’s high cigarette taxes, so it’s possible that more teens who might have otherwise chosen conventional cigarettes may be turning to e-cigarettes, according to Thomas A. Wills, lead author of the study and co-director of the Cancer Prevention and Control Program at the University of Hawaii. But even with this caveat, the research “raises the possibility that e-cigarettes are recruiting lower-risk adolescents who would otherwise be less susceptible to smoking,” Dr. Wills said.

“When you put this new research in the context of other studies and ask the question, ‘Are e-cigs leading to nicotine addition among kids and promoting smoking around kids?’, I think we’ve got enough information to answer, ‘yes,’ ” said Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. “We don’t have the longitudinal data to say that absolutely, positively, e-cigarettes are a gateway to smoking, but we have walked up to the door and opened it.”

Not so fast, said David B. Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies at Legacy, an antismoking research group. “This research is worrisome, but I don’t think you can say that this study supports the gateway theory; it’s still an open question,” said Dr. Abrams, who is concerned that the focus on e-cigs distracts from the greater health problem: combustible tobacco products and their cancer-causing tar. “Public enemy number one is still regular cigarettes, along with cigars, cigarillos and hookahs,” he said, and teenagers are using them at a higher rate than e-cigarettes.

But the multibillion dollar e-cigarette industry appears to be attracting a demographic of teens that public health officials thought they had protected from nicotine addiction after decades of antismoking campaigns. And even though e-cigarettes seem to be less harmful than traditional ones, they are far from harmless. They contain nicotine, which is a neurotoxin that’s particularly dangerous to young brains. E-cigarettes are made in China with little safety oversight (as reported in Sunday’s Times), and are unregulated in the United States because they are not yet categorized as either a tobacco product or a pharmaceutical. As a result, a variety of toxic chemicals have been found in e-cigarettes, including heavy metals, carcinogens, lead, formaldehyde and diethylene glycol, an ingredient used in antifreeze. It’s also worth noting that even the e-cigarette fluids that claim to be nicotine-free still deliver a hit of ultrafine particles that can contribute to lung conditions and cardiovascular disease.

The Food and Drug Administration is considering a regulation to ban the sale of e-cigarettes to minors, but that process could take a year or more. In the meantime, though some states have banned the sale of e-cigarettes to minors, there are no federal restrictions on e-cigarettes, their kid-friendly flavorings or how they are marketed. Tobacco companies have bought several e-cigarette companies and are targeting teens with all their might, making e-cigarettes and “vaping” look cool, sexy and glamorous. “E-cigarette marketing today looks like the heyday of broadcast cigarette advertising from decades ago,” Dr. Glantz said.

Even my 6-year-old could be lured by e-cigarette taglines like “Let It Glow,” to try a product I have a feeling Elsa would not endorse. The longer public health officials debate the pros and cons of e-cigarettes without instituting regulations, the more damage these products can do.

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We're all living the family dynamic, as parents, as children, as siblings, uncles and aunts. At Motherlode, lead writer and editor KJ Dell’Antonia invites contributors and commenters to explore how our families affect our lives, and how the news affects our families—and all families. Join us to talk about education, child care, mealtime, sports, technology, the work-family balance and much more